| NPI | 1205430444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 30839) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA 30839) |
| 103TC1900X Psychologist, Counseling (Licence: CA 30839) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 30839) | |
| 103TF0000X Psychologist, Family (Licence: CA 30839) | |
| 103TS0200X Psychologist, School (Licence: CA 30839) | |
| Enumeration Date | 2020-11-29 |
| Last Update Date | 2020-11-29 |