| NPI | 1922234525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 29025) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA 29025) |
| 103TC0700X Psychologist, Clinical (Licence: CA 29025) | |
| 103TC1900X Psychologist, Counseling (Licence: CA 29025) | |
| 103TH0100X Psychologist, Health Service (Licence: CA 29025) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CA 29025) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2023-02-15 |