| NPI | 1265524524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY22728) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC43355) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2013-04-11 |