| NPI | 1306222187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NV 1166) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO 0005996) |
| 103T00000X Psychologist (Licence: CA PSY29526) | |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2024-04-02 |