| NPI | 1679906614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI PSY-1750) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 30232) |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2022-03-16 |