| NPI | 1427179662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY26626) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY26626) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2022-01-11 |