| NPI | 1750366902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY14385) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MI 6301011373) |
| 103G00000X Clinical Neuropsychologist (Licence: CA PSY14385) | |
| 103T00000X Psychologist (Licence: MI 6301011373) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: CA PSY14385) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: MI 6301011373) | |
| 103TC0700X Psychologist Clinical (Licence: CA PSY14385) | |
| 103TC0700X Psychologist Clinical (Licence: MI 6301011373) | |
| 103TC1900X Psychologist Counseling (Licence: CA PSY14385) | |
| 103TC1900X Psychologist Counseling (Licence: MI 6301011373) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA PSY14385) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MI 6301011373) | |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2025-09-11 |