| NPI | 1902231772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: CA PSY26679) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA PSYC.PY.60865003) |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2026-07-14 |