| 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 |