| NPI | 1235989872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 22274) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 37459) |
| Enumeration Date | 2024-03-26 |
| Last Update Date | 2024-03-26 |