| NPI | 1881079770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: CA PSY20109) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY20109) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: CA PSY20109) | |
| 103TC0700X Psychologist Clinical (Licence: CA PSY20109) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA PSY20109) | |
| 103TP0814X Psychologist Psychoanalysis (Licence: CA PSY20109) | |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2015-07-21 |