| NPI | 1063725794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 27086) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: ID 202862) |
| 103TC0700X Psychologist, Clinical (Licence: OR 3673) | |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2024-02-06 |