NPI | 1083745152 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY28000) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 43233) |
Enumeration Date | 2007-03-08 |
Last Update Date | 2016-06-07 |