| NPI | 1831120468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY11090) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY11090) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY11090) | |
| 103TF0200X Psychologist, Forensic (Licence: CA PSY11090) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: CA PSY11090) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CA PSY11090) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: CA PSY11090) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2015-07-22 |