| NPI | 1699986000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA psy18784) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 1567) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2023-07-10 |