| NPI | 1083021232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 27441) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 6634020-3501) |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2025-04-29 |