| NPI | 1477876753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY28098) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ 4419) |
| Enumeration Date | 2010-03-01 |
| Last Update Date | 2024-02-20 |