| NPI | 1982803169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY25035) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 25035) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2020-05-30 |