| NPI | 1275786410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY35980) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ PSY4195) |
| Enumeration Date | 2008-10-31 |
| Last Update Date | 2025-08-22 |