| NPI | 1043532088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY22832) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CA 22832) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA 22832) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: CA 22832) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA 22832) | |
| 103TC0700X Psychologist, Clinical (Licence: CA 22832) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 22832) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CA 22832) | |
| Enumeration Date | 2010-02-18 |
| Last Update Date | 2016-05-19 |