| NPI | 1821687781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA AMFT115179) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA APCC6896) |
| Enumeration Date | 2021-01-14 |
| Last Update Date | 2021-01-14 |