| NPI | 1669753059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: UT 13759876-2501) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY25338) |
| Enumeration Date | 2011-08-30 |
| Last Update Date | 2024-04-27 |