| NPI | 1962455246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY09193) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 13759) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2011-02-09 |