| NPI | 1447488127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY19475) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: CA PSY19475) |
| 103TH0004X Psychologist Health (Licence: CA PSY19475) | |
| 103TR0400X Psychologist Rehabilitation (Licence: CA PSY19475) | |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2022-07-21 |