| NPI | 1740509884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ PSY005422) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY31560) |
| Enumeration Date | 2010-05-28 |
| Last Update Date | 2025-02-03 |