| NPI | 1932387214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY 20797) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NE 927) |
| Enumeration Date | 2008-02-08 |
| Last Update Date | 2022-07-15 |