| NPI | 1235603168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 7932) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SC 7932) |
| Enumeration Date | 2019-01-14 |
| Last Update Date | 2023-08-16 |