| NPI | 1003028721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 005077) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY9246) |
| 106H00000X Marriage & Family Therapist (Licence: CA MFT13850) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2021-10-26 |