| NPI | 1881699452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY12012) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY12012) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2013-07-15 |