| NPI | 1487918231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 24868) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: HI 1867) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2023-03-31 |