| NPI | 1326062225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 20938) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS 21056) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2010-12-07 |