| NPI | 1992111470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 28054) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 40647) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2026-01-20 |