| NPI | 1568718757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 28848) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: Y835265289516) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2020-08-22 |