| NPI | 1518027325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA PSY10002185) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY#22272) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2026-08-07 |