| NPI | 1164605317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 4335) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY36399) |
| Enumeration Date | 2007-12-11 |
| Last Update Date | 2026-04-22 |