| NPI | 1679644926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 23622) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 23622) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: CA 23622) | |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2024-07-15 |