| NPI | 1093721912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY15234) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY15234) |
| 103TC1900X Psychologist, Counseling (Licence: CA PSY15234) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2020-02-21 |