| NPI | 1851838726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY 10750) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: HI PSY 1331) |
| Enumeration Date | 2017-01-30 |
| Last Update Date | 2017-01-30 |