| NPI | 1215338405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN 4146) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY31401) |
| Enumeration Date | 2014-09-08 |
| Last Update Date | 2026-10-09 |