| NPI | 1184644304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY17249) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC37710) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2007-11-13 |