| NPI | 1689068264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CA 31412) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: IA 083818) |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2019-11-19 |