| NPI | 1902941990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 24293) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: CA 24293) |
| 106H00000X Marriage & Family Therapist (Licence: CA 48498) | |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2024-12-17 |