| NPI | 1942408992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 26391) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 49621) |
| 101YM0800X Counselor, Mental Health (Licence: CA IMF53246) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2021-11-07 |