| NPI | 1023167939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY15252) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFT 20870) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2018-08-28 |