| NPI | 1104372697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 31550) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2023-02-15 |