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 |