| NPI | 1609535012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 11787) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 32000) |
| Enumeration Date | 2021-12-13 |
| Last Update Date | 2022-07-12 |