| NPI | 1518215508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY29241) |
| Additional Taxonomies | 103T00000X Psychologist |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2012-08-22 |
| Last Update Date | 2026-05-30 |