| NPI | 1609184340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 26638) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 103TC0700X Psychologist, Clinical (Licence: CA 26638) | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2022-04-26 |