| NPI | 1801466933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 29964) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: CA 29964) |
| 103TH0004X Psychologist Health (Licence: CA 29964) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: CA 29964) | |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2021-06-30 |