| NPI | 1023040599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA psy 6629) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA psy 6629) |
| 106H00000X Marriage & Family Therapist (Licence: CA mfc 6318) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2015-08-25 |