| NPI | 1922287101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 22822) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 103TH0004X Psychologist, Health | |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2011-11-09 |