| NPI | 1902878366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY5030) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY5030) |
| 106H00000X Marriage & Family Therapist (Licence: CA LMFT6806) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY5030) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: CA PSY5030) | |
| 103TF0200X Psychologist, Forensic (Licence: CA PSY5030) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: CA PSY5030) | |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2007-07-08 |