| NPI | 1477573608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA PSY 16193) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: CA PSY 16193) |
| 103TR0400X Psychologist, Rehabilitation (Licence: CA PSY 16193) | |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY 16193) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2025-09-11 |