| NPI | 1528186053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C3088) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY20558) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2016-05-18 |