| NPI | 1205119633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA psy 24425) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA psy 24425) |
| 103T00000X Psychologist (Licence: CA psy 24425) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA psy 24425) | |
| 103TE1100X Psychologist, Exercise & Sports (Licence: psy 24425) | |
| 103TF0000X Psychologist, Family (Licence: CA psy 24425) | |
| 103TH0004X Psychologist, Health (Licence: CA psy 24425) | |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2018-12-14 |