| NPI | 1780762658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY25155) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| 103TF0000X Psychologist, Family | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2013-01-03 |