| NPI | 1710437850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY20196) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFT32862) |
| Enumeration Date | 2016-10-13 |
| Last Update Date | 2016-10-13 |