| NPI | 1124031364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY19852) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 41388) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2026-09-21 |