| NPI | 1508927179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY25108) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA mfc21937) |
| 106H00000X Marriage & Family Therapist (Licence: CA LMFT21937) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2018-07-03 |