| NPI | 1043453012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY27304) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM PSY-2023-0078) | |
| 106H00000X Marriage & Family Therapist (Licence: CA 48835) | |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2025-04-07 |