| NPI | 1871725788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 2653) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA Psy12030) |
| Enumeration Date | 2009-08-12 |
| Last Update Date | 2016-02-22 |