| NPI | 1083748305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 21367) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA MFT 30975) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2010-02-10 |