| 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 | 2022-08-29 |