| NPI | 1982969226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY31676) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA LMFT47165) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2020-04-27 |