| NPI | 1093597601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 34826) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VA 0810008701) |
| Enumeration Date | 2023-10-18 |
| Last Update Date | 2026-03-23 |