| NPI | 1093365736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY31171) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY31171) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: CA PSY31171) | |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY31171) | |
| 103TH0004X Psychologist, Health (Licence: CA PSY31171) | |
| Enumeration Date | 2019-09-15 |
| Last Update Date | 2024-09-04 |