| NPI | 1790207231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 29142) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 021523) |
| Enumeration Date | 2017-07-15 |
| Last Update Date | 2020-01-24 |