| NPI | 1891071890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY24928) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 018526) |
| 103TR0400X Psychologist, Rehabilitation (Licence: NY 018526) | |
| Enumeration Date | 2011-10-23 |
| Last Update Date | 2012-03-24 |