| NPI | 1154154847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY13355) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY13355) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: CA PSY13355) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA PSY13355) | |
| 103TF0000X Psychologist Family (Licence: CA PSY13355) | |
| 103TH0004X Psychologist Health (Licence: CA PSY13355) | |
| Enumeration Date | 2024-08-20 |
| Last Update Date | 2024-08-20 |