| NPI | 1316187743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY12636) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: CA PSY12636) |
| 103TA0700X Psychologist Adult Development & Aging (Licence: CA PSY12636) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA PSY12636) | |
| 103TF0000X Psychologist Family (Licence: CA PSY12636) | |
| 103TP0814X Psychologist Psychoanalysis (Licence: CA PSY12636) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: CA PSY12636) | |
| Enumeration Date | 2009-02-25 |
| Last Update Date | 2011-01-24 |