| NPI | 1235603168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 34462) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: SC 1907) |
| Enumeration Date | 2019-01-14 |
| Last Update Date | 2025-09-08 |