| NPI | 1942320270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY22448) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 002911) |
| 103TC0700X Psychologist, Clinical (Licence: NY 017792) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2009-03-02 |