| NPI | 1205963196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IA 072183) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103T00000X Psychologist (Licence: CA PSY 22237) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2025-02-25 |