| NPI | 1477899581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 34290) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 21146) |
| Enumeration Date | 2012-12-17 |
| Last Update Date | 2023-08-11 |