| NPI | 1285302372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 35091) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 024445) |
| Enumeration Date | 2021-09-02 |
| Last Update Date | 2024-09-03 |