| NPI | 1336270305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY23960) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103TC0700X Psychologist Clinical (Licence: CA PSY23960) | |
| 103TC1900X Psychologist Counseling (Licence: CA PSY23960) | |
| 103TF0000X Psychologist Family (Licence: CA PSY23960) | |
| 103TF0200X Psychologist Forensic (Licence: CA PSY23960) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: CA PSY23960) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2021-03-23 |