| NPI | 1578053682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA ASW92180) |
| 103TA0700X Psychologist, Adult Development & Aging | |
| 1041C0700X Social Worker, Clinical (Licence: CO CSW.09928142) | |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2024-09-25 |