| NPI | 1457456436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY15360) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: GA PSY2565) |
| 103TC0700X Psychologist Clinical (Licence: CA PSY15360) | |
| 103TC0700X Psychologist Clinical (Licence: GA PSY002565) | |
| 106H00000X Marriage & Family Therapist (Licence: CA MFC25135) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2023-10-02 |