| NPI | 1760082325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSB94028029) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 94028029) |
| 171M00000X Case Manager/Care Coordinator | |
| 101Y00000X Counselor | |
| 101YM0800X Counselor, Mental Health | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: CA 94028029) | |
| Enumeration Date | 2020-10-31 |
| Last Update Date | 2024-07-03 |