| NPI | 1619180049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY15781) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY15781) |
| 103TC1900X Psychologist, Counseling (Licence: CA PSY15781) | |
| 103TH0004X Psychologist, Health (Licence: CA PSY15781) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2007-07-08 |