| NPI | 1982644571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY14836) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 35S100355000) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2019-06-05 |