| NPI | 1528243821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0004X Psychologist Health (Licence: CA 24775) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 106H00000X Marriage & Family Therapist (Licence: CA 45805) | |
| Enumeration Date | 2008-01-04 |
| Last Update Date | 2012-06-20 |