| NPI | 1003386608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZE0500X Specialist/Technologist, Other, EEG |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 90683) |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2018-12-06 |