| NPI | 1578829271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY13680) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFCC23455) |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2012-05-22 |