| NPI | 1851587992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY 6777) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: HI 994) |
| 103TF0200X Psychologist Forensic | |
| Enumeration Date | 2007-09-22 |
| Last Update Date | 2007-09-22 |