| NPI | 1215462692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 35518) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 35518) |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2026-08-26 |