| NPI | 1083036537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA psy26074) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CA psy26074) |
| 103TF0000X Psychologist, Family (Licence: CA psy26074) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CA psy 26074) | |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2020-03-25 |