| NPI | 1104295096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 32397) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 024543) |
| Enumeration Date | 2015-09-21 |
| Last Update Date | 2025-05-29 |