| NPI | 1881078798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 34976) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 103K00000X Behavior Analyst | |
| 103T00000X Psychologist | |
| 103TF0200X Psychologist, Forensic | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2024-10-03 |