| NPI | 1528056686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: CA 26578) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: CO 3004) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2015-02-05 |