| NPI | 1881865194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 21880) |
| Additional Taxonomies | 103TH0004X Psychologist, Health |
| 103TH0100X Psychologist, Health Service | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2008-03-13 |
| Last Update Date | 2024-03-01 |