| NPI | 1942490230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY24607) |
| Additional Taxonomies | 101Y00000X Counselor |
| 103TH0100X Psychologist Health Service (Licence: CA PSY 24607) | |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2013-08-12 |