| NPI | 1942326038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: OR 1894) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY13841) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2024-08-15 |