| NPI | 1831213958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: CA PSY10888) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA PSY.10888) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2016-03-24 |