| NPI | 1558489138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY6653) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFT13752) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2007-07-08 |