| NPI | 1063046225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA psy31449) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY31449) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA psy31449) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA Psy31449) | |
| 103TH0004X Psychologist, Health (Licence: CA psy31449) | |
| Enumeration Date | 2020-02-26 |
| Last Update Date | 2020-02-26 |