NPI | 1235206806 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 28732) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 40403) |
Enumeration Date | 2006-11-29 |
Last Update Date | 2022-01-03 |