| NPI | 1093122608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY28837) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCSW61313) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2026-04-16 |