NPI | 1669684627 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY10987) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC17973) |
Enumeration Date | 2007-05-04 |
Last Update Date | 2015-11-04 |