| NPI | 1326187907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY20173) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA PSY20173) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY20173) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2023-10-25 |