| NPI | 1598804783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 16826) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103T00000X Psychologist (Licence: CA PSY 16826) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2010-11-02 |