| NPI | 1124488119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 32382) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NV PY0962) |
| Enumeration Date | 2016-03-03 |
| Last Update Date | 2023-10-05 |