| NPI | 1194197343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA LEP 2480) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA CATC O1012101852) |
| 101YP1600X Counselor, Pastoral (Licence: VA BCPCC 0318) | |
| 101YS0200X Counselor, School (Licence: CA R51A-BPPS-120047281) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA M-RAS O1012101852) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: CA LEP 2480) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA LEP 2480) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: CA LEP 2480) | |
| 103TS0200X Psychologist, School (Licence: CA R513-SP2-120047281) | |
| 1041S0200X Social Worker, School (Licence: CA R51A-BPPS-120047281) | |
| Enumeration Date | 2015-10-28 |
| Last Update Date | 2015-10-28 |