| NPI | 1376763235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 39716) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA psy7536) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2023-01-23 |