| NPI | 1912254103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY26870) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC35611) |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2015-09-03 |