| NPI | 1851430276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 3063) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OR 3603) |
| 103T00000X Psychologist (Licence: CA 16155) | |
| 103TC0700X Psychologist, Clinical (Licence: CA 16155) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 16155) | |
| 103TF0000X Psychologist, Family (Licence: CA 16155) | |
| 103TF0200X Psychologist, Forensic (Licence: CA 16155) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2020-11-10 |