| NPI | 1588715155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY24580) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2020-08-04 |