| 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 |