| NPI | 1437280179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY7448) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA Psy7448) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2013-06-18 |