| NPI | 1659677029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY33528) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 122801-III) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2011-02-02 |
| Last Update Date | 2022-10-07 |