| NPI | 1629381561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY30856) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 016241) |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2020-10-17 |