| NPI | 1861557571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA PSY 19617) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA LEP 2544) |
| 103TC0700X Psychologist Clinical (Licence: IL 071006466) | |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2014-07-07 |