| NPI | 1366926784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 15763) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: CA 180076997) |
| Enumeration Date | 2018-09-21 |
| Last Update Date | 2024-04-15 |