| NPI | 1275085789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA 22494) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 22494) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA 22494) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: CA 22494) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA 22494) | |
| 103TC0700X Psychologist, Clinical (Licence: CA 22494) | |
| 103TH0004X Psychologist, Health (Licence: CA 22494) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CA 22494) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: CA 22494) | |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2016-11-01 |