| NPI | 1265127468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 36761) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 025778-01) |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2026-06-16 |