NPI | 1518038736 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY27355) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 40827) |
Enumeration Date | 2006-11-10 |
Last Update Date | 2016-07-06 |