| NPI | 1255755898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 1423) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 12706) |
| Enumeration Date | 2014-02-18 |
| Last Update Date | 2021-12-29 |