| NPI | 1164438255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSB31319) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-07-16 |