| NPI | 1336261833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY10502) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY10502) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY10502) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY10502) | |
| 103TF0000X Psychologist, Family (Licence: CA PSY10502) | |
| 103TF0200X Psychologist, Forensic (Licence: CA PSY10502) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2020-02-24 |