| 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 |