| NPI | 1386746279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 15757) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 12865) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2021-06-08 |