| NPI | 1053836445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA Psy30102) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA Psy30102) |
| 103TF0000X Psychologist, Family (Licence: CA Psy30102) | |
| 103TF0200X Psychologist, Forensic (Licence: CA Psy30102) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CA Psy30102) | |
| 106H00000X Marriage & Family Therapist (Licence: CA 86502) | |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2022-07-21 |