| NPI | 1700079530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 20749) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TF0000X Psychologist Family | |
| 103TP2701X Psychologist Group Psychotherapy | |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2015-06-19 |