| NPI | 1366628836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 26879) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103G00000X Clinical Neuropsychologist (Licence: CA 26879) | |
| 103TC0700X Psychologist, Clinical (Licence: CA 26879) | |
| 103TH0004X Psychologist, Health (Licence: CA 26879) | |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2019-08-08 |