| NPI | 1326448788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY31720) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY31720) |
| 103TF0000X Psychologist, Family (Licence: CA PSY31720) | |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2021-03-25 |