| NPI | 1265050363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IA 136591) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 36879) |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2026-08-03 |