| NPI | 1578639530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 26914) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TC0700X Psychologist, Clinical (Licence: CA Waivered) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2022-12-16 |