| NPI | 1720119316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY15778) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY15778) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY15778) | |
| 103TH0100X Psychologist, Health Service (Licence: CA PSY15778) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CA PSY15778) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: CA PSY15778) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2011-08-02 |