| NPI | 1790560415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 36531) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA WAIVERED) |
| Enumeration Date | 2023-08-30 |
| Last Update Date | 2026-01-24 |