| NPI | 1699186858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 28650) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TH0004X Psychologist, Health | |
| Enumeration Date | 2014-05-09 |
| Last Update Date | 2018-09-17 |