| NPI | 1922546829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 35030) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 89924) |
| Enumeration Date | 2017-02-10 |
| Last Update Date | 2024-05-16 |