| NPI | 1366673782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 27244) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH8849) |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2024-08-07 |