| NPI | 1871968297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 31377) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 2895) |
| 106H00000X Marriage & Family Therapist (Licence: CA 88530) | |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2021-06-30 |