| NPI | 1639654940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 36247) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NM PSY-2025-0055) |
| 103T00000X Psychologist (Licence: HI PSY-2286) | |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2025-12-17 |