| NPI | 1912339540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY29056) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TC1900X Psychologist, Counseling | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TE1100X Psychologist, Exercise & Sports | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2024-06-28 |