| NPI | 1366593733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY15267) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA PSY15267) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY15267) | |
| Enumeration Date | 2007-01-14 |
| Last Update Date | 2017-11-02 |