| NPI | 1063855336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY25675) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY11748) |
| 103TH0004X Psychologist, Health (Licence: CA PSY25675) | |
| 103TC0700X Psychologist, Clinical (Licence: IL 071-009052) | |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2026-02-04 |