| NPI | 1790737120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC32596) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA mft32596) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2014-04-21 |