| NPI | 1679602403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY17200) |
| Additional Taxonomies | 102L00000X Psychoanalyst |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2026-04-16 |