| NPI | 1619139078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA Waivered) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF80159) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2020-04-07 |