| NPI | 1710081252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA M 13509) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY 9149) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY 9149) | |
| 103TF0000X Psychologist, Family (Licence: CA PSY 9149) | |
| 103T00000X Psychologist (Licence: CA PSY 9149) | |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2025-09-11 |