| NPI | 1841486404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY27657) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 54130) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2022-01-25 |