| NPI | 1558301549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP2701X Psychologist, Group Psychotherapy (Licence: CA PSY 8983) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY 8983) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY 8983) | |
| 103TH0100X Psychologist, Health Service (Licence: CA PSY 8983) | |
| 103T00000X Psychologist (Licence: CA PSY 8983) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2025-09-11 |