| NPI | 1821011438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 23847) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 013359) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2024-05-23 |