| NPI | 1407865660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA NP22980) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 13975) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY13975) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2025-09-17 |