| NPI | 1487427779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA psy34787) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 026088) |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2024-02-02 |