| NPI | 1063141745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 41330) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 36171) |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2026-08-26 |