| NPI | 1215102991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA PSY 24549) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CA PSY24549) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2021-08-12 |