| NPI | 1831386085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60870549) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY25517) |
| 103TC1900X Psychologist, Counseling | |
| 101YM0800X Counselor, Mental Health | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103G00000X Clinical Neuropsychologist | |
| 103TC0700X Psychologist, Clinical (Licence: OR 2416) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| Enumeration Date | 2007-10-02 |
| Last Update Date | 2020-09-24 |