| NPI | 1740616606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 30539) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA 3412) |
| 103K00000X Behavior Analyst (Licence: CA 1-12-10028) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 30539) | |
| 103TC1900X Psychologist, Counseling (Licence: CA 30539) | |
| 103T00000X Psychologist (Licence: CA 30539) | |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2025-10-02 |