| NPI | 1881773356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY22423) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA UNLICENSED) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2013-07-24 |