| NPI | 1306980982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA Psy 25127) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFT 24073) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2012-08-27 |