| NPI | 1619021599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 30995) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: PA PS007712-L) |
| 103TC0700X Psychologist, Clinical (Licence: PA PS007712L) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2019-07-11 |