| NPI | 1902116676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY 11789) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CA OT 5173) |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2010-10-15 |