| NPI | 1467128876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 3991) |
| Additional Taxonomies | 174400000X Specialist |
| 103TC0700X Psychologist, Clinical (Licence: CA 35135) | |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2025-08-07 |