| NPI | 1003220500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY35416) |
| Additional Taxonomies | 101Y00000X Counselor |
| 103T00000X Psychologist | |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2025-09-11 |