| NPI | 1265839138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY27569) |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: CA PSY27569) |
| 103TE1100X Psychologist, Exercise & Sports (Licence: CA PSY27569) | |
| 103T00000X Psychologist (Licence: CA PSB 94020704) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CA PSB 94020704) | |
| Enumeration Date | 2014-11-20 |
| Last Update Date | 2020-09-10 |