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 |