| NPI | 1114315959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA psy1739) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA psy1739) |
| Enumeration Date | 2015-01-01 |
| Last Update Date | 2015-01-01 |