| NPI | 1902513914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY20356) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: ID PSY-20308) |
| Enumeration Date | 2022-10-31 |
| Last Update Date | 2024-05-14 |