| NPI | 1588004709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY32540) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103T00000X Psychologist (Licence: PA PS018984) | |
| 103T00000X Psychologist (Licence: CA PSY32540) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2023-01-19 |