| NPI | 1679200471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 4521033015) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 74125) |
| 103TC0700X Psychologist, Clinical (Licence: UT 11564758-4805) | |
| Enumeration Date | 2022-08-02 |
| Last Update Date | 2023-12-22 |