| NPI | 1275782302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA PSY15739) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: CA PSY15739) |
| 103TC0700X Psychologist Clinical (Licence: CA PSY15739) | |
| 103TF0200X Psychologist Forensic (Licence: CA PSY15739) | |
| 103TH0004X Psychologist Health (Licence: CA PSY15739) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: CA PSY15739) | |
| Enumeration Date | 2008-09-12 |
| Last Update Date | 2008-09-12 |