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 |