| NPI | 1356045181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 35202) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2025-11-27 |