| NPI | 1538361365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY 5769) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFT 6551) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2009-03-09 |