| NPI | 1750731246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY13760) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY13760) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA PSY13760) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: CA PSY13760) | |
| 103TC0700X Psychologist, Clinical (Licence: WA PY60626989) | |
| 103TE1100X Psychologist, Exercise & Sports (Licence: CA PSY13760) | |
| 103TF0200X Psychologist, Forensic (Licence: CA PSY13760) | |
| 103TH0004X Psychologist, Health (Licence: CA PSY13760) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CA PSY13760) | |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2016-06-15 |