| NPI | 1417259466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY20785) |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: CA PSY20785) |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2019-05-17 |