| NPI | 1154635571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA CA PSY 28312) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 103T00000X Psychologist | |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2016-09-30 |