NPI | 1275654824 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA 20325) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 17324) |
Enumeration Date | 2007-04-02 |
Last Update Date | 2022-01-03 |