| NPI | 1427623206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 3612) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 40636) |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2021-05-24 |