| NPI | 1881731685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AR 202267) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY 15944) |
| 103TC0700X Psychologist, Clinical (Licence: CO 3097) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2023-02-13 |