| NPI | 1598811705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY14235) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS14392) |
| Enumeration Date | 2007-01-28 |
| Last Update Date | 2012-07-06 |