| NPI | 1578549887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 35096) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: IL 071-006818) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2025-02-27 |