| NPI | 1164530812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY26848) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NV PY0791) |
| 103TC0700X Psychologist, Clinical (Licence: AZ 3413) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2017-12-27 |