| NPI | 1235270851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 38770) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 24379) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY24379) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2026-06-05 |