| NPI | 1063757011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY27821) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA LMFT85354) |
| 103TC0700X Psychologist, Clinical (Licence: CA 27821) | |
| Enumeration Date | 2012-12-03 |
| Last Update Date | 2025-10-08 |