| NPI | 1962578559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY 21734) |
| Additional Taxonomies | 103TF0000X Psychologist, Family |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2011-09-27 |