| NPI | 1720450638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 27474) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: CA 27474) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA 27474) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 27474) | |
| 103TH0004X Psychologist, Health (Licence: CA 27474) | |
| 103TH0100X Psychologist, Health Service (Licence: CA 27474) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CA 27474) | |
| Enumeration Date | 2015-10-30 |
| Last Update Date | 2015-10-30 |