| NPI | 1013072560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY7216) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 16349) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2007-07-09 |