| NPI | 1649318015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY22993) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY22993) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY22993) | |
| 103TC1900X Psychologist, Counseling (Licence: CA PSY22993) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY22993) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2023-12-06 |