| NPI | 1861038846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY19494) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY19495) |
| 106H00000X Marriage & Family Therapist (Licence: CA 33175) | |
| Enumeration Date | 2019-11-25 |
| Last Update Date | 2020-01-09 |