| NPI | 1881007672 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 35901)  | 
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 3198)  | 
| 106H00000X Marriage & Family Therapist (Licence: WI 1031-124)  | |
| Enumeration Date | 2014-06-09 | 
| Last Update Date | 2025-06-21 |