| NPI | 1912494352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC40195) |
| Additional Taxonomies | 102L00000X Psychoanalyst |
| Enumeration Date | 2018-04-20 |
| Last Update Date | 2018-04-20 |