| NPI | 1952824286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY29410) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 024201) |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2023-08-24 |