| NPI | 1891038352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA psy9191) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA PsY9191) |
| 101YM0800X Counselor, Mental Health (Licence: CA PSY9191) | |
| 101YP2500X Counselor, Professional (Licence: CA PSY9191) | |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2020-06-09 |