NPI | 1871668749 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 23484) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2006-11-22 |
Last Update Date | 2011-03-17 |