NPI | 1619128121 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY20146) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: ID LMFT 2921) |
Enumeration Date | 2008-10-02 |
Last Update Date | 2010-05-11 |