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 |