| NPI | 1114762853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 35378) |
| 103TH0004X Psychologist, Health | |
| Enumeration Date | 2024-06-25 |
| Last Update Date | 2026-01-28 |