| NPI | 1346324332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 30970) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 4558) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2025-02-19 |