| NPI | 1891059796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 33013) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: VA BCPC 0593) |
| 103TC0700X Psychologist, Clinical (Licence: NY 024368) | |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2022-08-03 |