| NPI | 1831466887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 32803) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 22769) |
| Enumeration Date | 2011-11-18 |
| Last Update Date | 2022-03-17 |