| NPI | 1518064807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TF0000X Psychologist Family (Licence: CA LMFT36747) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CA LPCC809) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2022-07-21 |