| NPI | 1942420591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 9064) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA 9064) |
| 103TC0700X Psychologist, Clinical (Licence: CA 9064) | |
| 103TC1900X Psychologist, Counseling (Licence: CA 9064) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 9064) | |
| 103TF0200X Psychologist, Forensic (Licence: CA 9064) | |
| 103TH0004X Psychologist, Health (Licence: CA 9064) | |
| 103TP0814X Psychologist, Psychoanalysis (Licence: CA 9064) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2007-07-08 |