| NPI | 1891393963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY34918) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS019108) |
| Enumeration Date | 2020-10-12 |
| Last Update Date | 2024-06-28 |