NPI | 1699186502 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 29415) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2014-05-13 |
Last Update Date | 2022-07-21 |