| NPI | 1114166402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CA 32439) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 32439) |
| 251B00000X Case Management | |
| Enumeration Date | 2009-02-11 |
| Last Update Date | 2023-08-03 |