| NPI | 1942270541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA psy 20248) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA psy 20248) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2013-06-21 |