| NPI | 1437486412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 35958) |
| 104100000X Social Worker | |
| Enumeration Date | 2009-11-11 |
| Last Update Date | 2025-06-28 |