| NPI | 1306973458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 0710010593) |
| Additional Taxonomies | 101Y00000X Counselor |
| 103TC0700X Psychologist, Clinical (Licence: CA 25749) | |
| 106H00000X Marriage & Family Therapist (Licence: CA 34847) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2022-04-08 |