| NPI | 1912006024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY22883) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC42299) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2019-03-28 |