| NPI | 1144395815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY79550) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC13763) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2009-03-10 |