| NPI | 1538227186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 25353) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY 25353) |
| 103TF0000X Psychologist, Family (Licence: CA PSY 25353) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2020-05-08 |