| NPI | 1114405420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY30154) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 024310) |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2021-12-10 |