| NPI | 1891158432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IA 122027) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional (Licence: CA PCCI4118) | |
| 103TC0700X Psychologist, Clinical (Licence: IA 0051) | |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2023-08-29 |