| NPI | 1972675890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY28298) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 012997) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2019-10-29 |