| NPI | 1285465955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 124747) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA ASW124747) |
| Enumeration Date | 2024-08-13 |
| Last Update Date | 2024-12-11 |