| NPI | 1366442527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY17903) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 022908) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2019-05-08 |