| NPI | 1598980252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 3126) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC35972) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2019-11-24 |