| NPI | 1588143960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSB94025279) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSB94024242) |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2024-06-21 |