| NPI | 1083754089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI PSY 454) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY28367) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2019-11-18 |