| NPI | 1457073538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL 12998) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 36278) |
| Enumeration Date | 2022-09-14 |
| Last Update Date | 2025-10-27 |