| NPI | 1619143641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 34093) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: HI 1332) |
| 103TH0004X Psychologist, Health (Licence: HI 1332) | |
| 103TH0004X Psychologist, Health (Licence: CA 34093) | |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2024-05-24 |