| NPI | 1245730308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CA PSY35762) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 10555235-6009) |
| Enumeration Date | 2018-02-15 |
| Last Update Date | 2025-08-12 |