| NPI | 1033430889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 18012) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: HI PSY 669) |
| 103T00000X Psychologist (Licence: ZZ 90 03316) | |
| 103T00000X Psychologist (Licence: CA PSY 18012) | |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2019-03-27 |