| NPI | 1235658295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 36081) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 5469-57) |
| 103T00000X Psychologist (Licence: RI PS02397) | |
| 103T00000X Psychologist (Licence: CO PSY.0006835) | |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2026-03-03 |