| NPI | 1891810438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY-29785) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA LCS 24862) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2018-03-27 |