| NPI | 1811631815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA PSB94029134) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist, Clinical (Licence: CA PSB94029134) | |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2026-01-29 |