| NPI | 1508109612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY28998) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA PSY28998) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2025-05-12 |