| NPI | 1295841500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 18050) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 015966) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2018-12-13 |