NPI | 1467577064 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 19307) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 12290) |
Enumeration Date | 2007-03-20 |
Last Update Date | 2013-05-28 |