| NPI | 1114567310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY31555) |
| Additional Taxonomies | 103TP0814X Psychologist Psychoanalysis (Licence: CA PSY31555) |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2024-04-05 |