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 |