| NPI | 1568847697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY11365) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFT24336) |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2015-07-30 |