| NPI | 1881913721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY25520) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OR 2054) |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2022-06-21 |