| NPI | 1447580105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY 24612) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA 26028) |
| Enumeration Date | 2009-12-31 |
| Last Update Date | 2020-11-16 |