NPI | 1659493302 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY12441) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFT23533) |
Enumeration Date | 2007-04-04 |
Last Update Date | 2007-07-08 |