| NPI | 1205908878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 32504) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA LPCC 248) |
| 106H00000X Marriage & Family Therapist (Licence: CA 50497) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2021-05-14 |