| NPI | 1700910742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY23433) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NM 2022-0136) |
| 103TC0700X Psychologist, Clinical (Licence: TX 37928) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2024-04-05 |