| NPI | 1962506154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 32601) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 1915057) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2023-10-03 |