| NPI | 1932584539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY14963) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: CA PSY14963) |
| 103TP2701X Psychologist Group Psychotherapy (Licence: CA PSY14963) | |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2022-02-11 |