| NPI | 1760630396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY27541) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA RPS-2012307) |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2024-12-02 |