| NPI | 1750316162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA LEP 1252) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFT 19168) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2023-09-06 |