| NPI | 1184881559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 27956) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 27956) |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2024-09-10 |