| NPI | 1871681940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 17717) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA #PSY17717) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2012-10-25 |