| NPI | 1093950982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 32495) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2008-12-08 |
| Last Update Date | 2023-01-13 |