| NPI | 1588987994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY14007) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC14374) |
| Enumeration Date | 2010-03-12 |
| Last Update Date | 2012-12-19 |