NPI | 1013247238 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY25250) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFT27618) |
Enumeration Date | 2010-01-11 |
Last Update Date | 2015-10-14 |