| NPI | 1265661250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY12745) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFT18023) |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2009-07-10 |