| NPI | 1437299559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY30533) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2022-02-28 |