| NPI | 1306063144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 102L00000X Psychoanalyst (Licence: CA MFT 9248) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFT 9248) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2007-07-08 |