| NPI | 1841846151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY30901) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS020406) |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2025-08-04 |