| NPI | 1609055797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY34180) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: CA PSY34180) | |
| Enumeration Date | 2007-10-25 |
| Last Update Date | 2023-06-08 |