| NPI | 1821444985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 29171) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA LCS26040) |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2018-07-22 |