| NPI | 1205032596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY24653) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103T00000X Psychologist (Licence: CA psy24653) | |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2022-02-08 |