| NPI | 1922039189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 5593) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY15369) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2020-05-27 |