| NPI | 1760637607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 14289) |
| Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: CA PSY 14289) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CA PSY 14289) | |
| Enumeration Date | 2008-11-19 |
| Last Update Date | 2008-11-19 |