| NPI | 1619224078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 9161) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: CA 9161) |
| 103TC1900X Psychologist Counseling (Licence: CA 9161) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: CA 9161) | |
| Enumeration Date | 2012-08-04 |
| Last Update Date | 2012-08-04 |