| NPI | 1760644959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY9610) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC17125) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2015-06-09 |