| NPI | 1700958345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY25154) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY25154) |
| 103TF0000X Psychologist, Family (Licence: CA PSY25154) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CA PSY25154) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2020-01-03 |