| NPI | 1912924994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY 5556) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging (Licence: CA PSY5556) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: CA PSY5556) | |
| 103TC0700X Psychologist Clinical (Licence: CA PSY 5556) | |
| 103TE1100X Psychologist Exercise & Sports (Licence: CA PSY 5556) | |
| 103TF0000X Psychologist Family (Licence: CA PSY 5556) | |
| 103TF0200X Psychologist Forensic (Licence: CA PSY 5556) | |
| 103TH0100X Psychologist Health Service (Licence: CA PSY 5556) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2017-01-18 |