| NPI | 1841206109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY12890) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CO 1436) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-07-08 |