| NPI | 1952535437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0004669) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY 22678) |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2020-03-19 |