| NPI | 1205834058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 21635) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY 21635) |
| 103TE1100X Psychologist, Exercise & Sports (Licence: CA PSY 21635) | |
| 103TF0000X Psychologist, Family (Licence: CA PSY 21635) | |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2019-12-04 |