| NPI | 1801285903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY33885) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103T00000X Psychologist (Licence: CA PSY33885) | |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2025-05-09 |