| NPI | 1043366396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 6716) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 6716) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2025-09-11 |