| NPI | 1811203417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY19277) |
| Additional Taxonomies | 103TF0000X Psychologist Family (Licence: CA PSY 19277) |
| 103TF0200X Psychologist Forensic (Licence: CA PSY 19277) | |
| 103TH0100X Psychologist Health Service (Licence: CA PSY 19277) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: CA PSY 19277) | |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2010-08-20 |