| NPI | 1154584894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 25842) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) |
| 103TH0100X Psychologist Health Service | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2022-12-08 |