| NPI | 1215789276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY36084) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IA 122557) |
| Enumeration Date | 2024-04-03 |
| Last Update Date | 2025-10-28 |