| NPI | 1417027483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY11951) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging (Licence: CA PSY11951) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: CA PSY11951) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA PSY11951) | |
| 103TF0200X Psychologist Forensic (Licence: CA PSY11951) | |
| 103TH0100X Psychologist Health Service (Licence: CA PSY11951) | |
| 103T00000X Psychologist (Licence: CA PSY11951) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: CA PSY11951) | |
| 103TR0400X Psychologist Rehabilitation (Licence: CA PSY1951) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2009-06-11 |