| NPI | 1417008673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY 23144) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA PSY 23144) |
| 103TF0000X Psychologist Family (Licence: CA PSY 23144) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: CA PSY 23144) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: CA PSY23144) | |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2018-12-14 |