| NPI | 1750752846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 32773) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 32773) |
| Enumeration Date | 2015-10-14 |
| Last Update Date | 2025-05-28 |