| NPI | 1881704864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY9633) |
| 103T00000X Psychologist (Licence: CA PSY9633) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-08 |