| NPI | 1679822480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY27893) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC46279) |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2021-04-09 |