| NPI | 1679395701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 35451) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: CA 35451) |
| Enumeration Date | 2024-10-29 |
| Last Update Date | 2024-11-06 |