| NPI | 1942331541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY23940) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IL 071-005151) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2019-09-06 |