| NPI | 1457723223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 30873) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY25831) |
| 103T00000X Psychologist (Licence: CA PSB 94021221) | |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2023-04-05 |