| NPI | 1801360060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY31957) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 35SI00393500) |
| Enumeration Date | 2019-01-21 |
| Last Update Date | 2021-06-08 |