| NPI | 1497900153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 23440) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: LA 1111) |
| 103TS0200X Psychologist School (Licence: LA 1111) | |
| 103T00000X Psychologist (Licence: CA 23440) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA 23440) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: CA 23440) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: LA 1111) | |
| Enumeration Date | 2008-11-22 |
| Last Update Date | 2010-04-07 |