| NPI | 1588152573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 94025464) |
| Additional Taxonomies | 103TF0000X Psychologist Family (Licence: CA 94025464) |
| 103TF0000X Psychologist Family | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: CA 94025464) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: CA 94025464) | |
| 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: CA 94025464) | |
| 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2023-10-19 |