| NPI | 1518530443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY36465) |
| Additional Taxonomies | 103T00000X Psychologist |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2026-02-17 |