| NPI | 1891120002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: CA PSY31556) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA F4744951) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY31556) | |
| Enumeration Date | 2013-09-06 |
| Last Update Date | 2020-04-29 |