| NPI | 1497922967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY32482) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WY 529) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2023-07-13 |