| NPI | 1396942025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 2144) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY 18903) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2023-06-07 |