| NPI | 1013372713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 27900) |
| Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: CA PSY27900) |
| Enumeration Date | 2015-12-22 |
| Last Update Date | 2022-07-21 |