| NPI | 1104851963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 13676) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CA PSY 13676) |
| 103TF0000X Psychologist, Family (Licence: CA PSY 13676) | |
| 103T00000X Psychologist (Licence: CA PSY 13676) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2010-08-20 |