| NPI | 1992783112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 21811) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NC 3245) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2010-05-28 |