| NPI | 1285091124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CA PSY18551) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY18551) |
| 103TE1100X Psychologist, Exercise & Sports (Licence: CA PSY18551) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: CA PSY18551) | |
| 103T00000X Psychologist (Licence: CA PSY18551) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY18551) | |
| Enumeration Date | 2016-01-22 |
| Last Update Date | 2026-09-03 |