| NPI | 1790348894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: CA 1497093355) |
| Additional Taxonomies | 101YS0200X Counselor School (Licence: CA 1497093355) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2021-07-09 |