| NPI | 1053506147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY23388) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 23846) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2023-06-07 |