| NPI | 1205223849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY34178) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 9133595-6010) |
| 103G00000X Clinical Neuropsychologist | |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2026-08-12 |