| NPI | 1124141031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY 19014) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY 19014) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: CA PSY 19014) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: CA PSY 19014) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: CA PSY 19014) | |
| 103TC0700X Psychologist Clinical (Licence: CA PSY 19014) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA PSY 19014) | |
| 103TF0000X Psychologist Family (Licence: CA PSY 19014) | |
| 103TF0200X Psychologist Forensic (Licence: CA PSY 19014) | |
| 103TR0400X Psychologist Rehabilitation (Licence: CA PSY 19014) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2016-04-12 |