| NPI | 1114485323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 30680) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: 15487) |
| Enumeration Date | 2019-03-06 |
| Last Update Date | 2023-11-16 |