| NPI | 1457559783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY32525) |
| Additional Taxonomies | 101Y00000X Counselor |
| 103T00000X Psychologist | |
| 251S00000X | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-07-09 |
| Last Update Date | 2023-07-29 |