| NPI | 1932479086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 24076) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 019329-1) |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2023-09-12 |