| NPI | 1699229005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY31305) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY31305) |
| 103T00000X Psychologist | |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2026-02-04 |