| NPI | 1508997206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY13509) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY13509) |
| 103TF0200X Psychologist Forensic (Licence: CA PSY13509) | |
| 103TH0100X Psychologist Health Service (Licence: CA PSY13509) | |
| 106H00000X Marriage & Family Therapist (Licence: CA PSY13509) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2007-07-09 |