| NPI | 1952412488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 15568) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: 15568) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 15568) | |
| 103T00000X Psychologist (Licence: CA 15568) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CA 15568) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2016-04-22 |