| NPI | 1619170958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 16601) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 23813) |
| 174400000X Specialist (Licence: CA 25147) | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2022-07-25 |