| NPI | 1558473876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0700X Psychologist, Adult Development & Aging (Licence: CA PSY7206) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY7206) |
| 103TC1900X Psychologist, Counseling (Licence: CA PSY7206) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY7206) | |
| 103TF0200X Psychologist, Forensic (Licence: CA PSY7206) | |
| 103T00000X Psychologist (Licence: CA PSY7206) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-08 |