| NPI | 1396057550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY30512) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 020974) |
| Enumeration Date | 2010-07-04 |
| Last Update Date | 2021-04-07 |