| NPI | 1902114523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY 23623) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY 23623) |
| 103TC1900X Psychologist, Counseling (Licence: CA PSY 23623) | |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2010-09-16 |