| NPI | 1851549737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY25096) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 36861) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2021-03-16 |