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 |