| NPI | 1881704864 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY9633) | 
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral | 
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY9633) | |
| Enumeration Date | 2006-08-30 | 
| Last Update Date | 2025-09-11 |