| NPI | 1922127083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA Psy 17118) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: CA Psy 17118) |
| 103T00000X Psychologist (Licence: CA Psy 17118) | |
| 1041C0700X Social Worker, Clinical (Licence: CA LCSW 8827) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2007-07-08 |