| NPI | 1023149861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA MFC50440) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA PBS32170) |
| 106H00000X Marriage & Family Therapist (Licence: CA MFC50440) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2014-01-15 |