| NPI | 1699399899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 140198) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2025-04-26 |