| NPI | 1255465266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY12302) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY12302) |
| 103TA0700X Psychologist Adult Development & Aging (Licence: CA PSY12302) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: CA PSY12302) | |
| 103TC0700X Psychologist Clinical (Licence: CA PSY12302) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA PSY12302) | |
| 103TF0000X Psychologist Family (Licence: CA PSY12302) | |
| 103TH0100X Psychologist Health Service (Licence: CA PSY12302) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: CA PSY12302) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: CA PSY12302) | |
| 103TR0400X Psychologist Rehabilitation (Licence: CA PSY12302) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2012-02-06 |