| NPI | 1376193177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 31496) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS 2729) |
| Enumeration Date | 2019-09-13 |
| Last Update Date | 2024-01-31 |