| NPI | 1073861217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY31294) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IL 180008239) |
| Enumeration Date | 2012-08-20 |
| Last Update Date | 2024-04-26 |