| NPI | 1184993602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY34286) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS 27744) |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2011-12-29 |
| Last Update Date | 2023-07-14 |