| NPI | 1093775298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 339370-2501) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY25322) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2021-12-20 |