| NPI | 1700267721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: CA PSB94024755) | |
| 103T00000X Psychologist | |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2024-04-19 |