| NPI | 1972935328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY25867) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: CA PSY25867) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY25867) | |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2013-09-18 |