| NPI | 1578721734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC36587) |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2008-05-23 |
| Last Update Date | 2015-07-01 |