| NPI | 1053689786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY33579) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2011-12-08 |
| Last Update Date | 2022-12-28 |