| NPI | 1770946402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 33289) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 33289) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2025-02-25 |