| NPI | 1477718468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY 22560) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY 22560) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY 22560) | |
| 103TC1900X Psychologist, Counseling (Licence: CA PSY 22560) | |
| 103TE1100X Psychologist, Exercise & Sports (Licence: CA PSY 22560) | |
| 103TH0004X Psychologist, Health (Licence: CA PSY 22560) | |
| Enumeration Date | 2008-07-19 |
| Last Update Date | 2010-10-19 |