| NPI | 1710184593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY 23128) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 40650) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2017-04-25 |