| NPI | 1629129176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY15066) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY15066) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA PSY15066) | |
| 103TF0000X Psychologist Family (Licence: CA PSY15066) | |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2020-07-13 |