NPI | 1366790610 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY29316) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2012-08-16 |
Last Update Date | 2021-09-17 |