| NPI | 1730350109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CA A1490539) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA A1490539) |
| Enumeration Date | 2008-03-13 |
| Last Update Date | 2008-03-13 |