| NPI | 1922668292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSB94027441) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 106H00000X Marriage & Family Therapist (Licence: CA 114902) | |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2024-01-31 |