| NPI | 1194870949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 20624) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 38529) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY 20624) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2018-03-17 |