| NPI | 1790207736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 36689) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 11791359-2501) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2026-08-21 |