| NPI | 1508426958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY14513) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PSY14513) |
| 103TF0000X Psychologist, Family (Licence: PSY14513) | |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2019-06-18 |