| NPI | 1508590431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CA PSY34385) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2022-07-15 |
| Last Update Date | 2023-08-06 |