NPI | 1316918279 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY7722) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC17359) |
Enumeration Date | 2006-01-30 |
Last Update Date | 2011-12-09 |