| NPI | 1780031831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY28313) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY28313) |
| 103TF0000X Psychologist, Family (Licence: CA PSY28313) | |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2019-01-10 |