| NPI | 1922293497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY24947) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA RPS2010173) |
| Enumeration Date | 2007-09-07 |
| Last Update Date | 2023-09-28 |