| NPI | 1013230036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP2701X Psychologist, Group Psychotherapy (Licence: CA MFC32601) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2010-03-04 |
| Last Update Date | 2010-03-04 |