| NPI | 1699384651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY32257) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 3812-57) |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2022-03-21 |