| NPI | 1952704306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NH 1522) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY32105) |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2021-03-18 |