| NPI | 1407474307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 35949) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NV PY1243) |
| 103TC0700X Psychologist, Clinical (Licence: IA 115965) | |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2025-07-11 |