| 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, Intellectual & Developmental Disabilities (Licence: CA PSY15739) | |
| Enumeration Date | 2008-09-12 |
| Last Update Date | 2008-09-12 |