| NPI | 1457609802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CA 29584) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071.008407) |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2023-05-02 |