| NPI | 1003220500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 35416) |
| Additional Taxonomies | 103T00000X Psychologist |
| 101Y00000X Counselor | |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2024-10-30 |