| NPI | 1265596134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY 15091) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA PSY 15091) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA PSY 15091) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: CA PSY 15091) | |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY 15091) | |
| 103TC1900X Psychologist, Counseling (Licence: CA PSY 15091) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY 15091) | |
| 103TE1100X Psychologist, Exercise & Sports (Licence: CA PSY 15091) | |
| 103TF0000X Psychologist, Family (Licence: CA PSY 15091) | |
| 103TF0200X Psychologist, Forensic (Licence: CA PSY 15091) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CA PSY 15091) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2015-11-02 |