| NPI | 1659650679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 103K00000X Behavior Analyst | |
| 103T00000X Psychologist (Licence: CA Psy29259) | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC0700X Psychologist, Clinical (Licence: CA Psy29259) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA Psy29259) | |
| 103TF0000X Psychologist, Family | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 106H00000X Marriage & Family Therapist (Licence: CA 65423) | |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2025-01-25 |