| NPI | 1366004467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSB94023768) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2023-12-06 |