| NPI | 1508429663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: CA 33136) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: HI 1916) |
| 103TH0100X Psychologist, Health Service (Licence: NY 026945) | |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2026-08-18 |