| NPI | 1902155997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 35533) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2025-09-04 |