| NPI | 1194974717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY33877) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCSW59618) |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2023-10-16 |