| NPI | 1790088656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY26684) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 10984796-2501) |
| 103TC0700X Psychologist, Clinical (Licence: NV PY0947) | |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2024-01-24 |