NPI | 1902941990 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA 24293) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 48498) |
Enumeration Date | 2007-02-20 |
Last Update Date | 2014-07-23 |