| NPI | 1881244986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY33685) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS018903) |
| 103T00000X Psychologist (Licence: NY 024751) | |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2024-06-14 |