| NPI | 1174897714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY21424) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS 21289) |
| Enumeration Date | 2012-02-29 |
| Last Update Date | 2021-03-23 |