| NPI | 1972867984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 28428) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY13224) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2026-07-01 |