| NPI | 1952495020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 23682) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA 23682) |
| 103TF0000X Psychologist, Family (Licence: CA 23682) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: CA 23682) | |
| 103TC0700X Psychologist, Clinical (Licence: CA 23682) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2014-08-28 |