| NPI | 1336429000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY 23917) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY 23917) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: CA PSY 23917) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: VA 0810004408) | |
| 103TC0700X Psychologist Clinical (Licence: VA 0810004408) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA PSY 23917) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: VA 0810004408) | |
| 103TF0200X Psychologist Forensic | |
| 103TF0200X Psychologist Forensic (Licence: CA PSY23917) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: VA 0810004408) | |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2022-01-11 |