| NPI | 1649606013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 35954) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCSW101591) |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2026-03-24 |