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 |