| NPI | 1932599503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY28925) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071009030) |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2026-08-24 |