| NPI | 1013909506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AL 951) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 23004) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2023-03-02 |