| NPI | 1407997158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 49074) |
| Additional Taxonomies | 101Y00000X Counselor |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA 49074) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2022-01-07 |