| NPI | 1962419549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 9835) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 9835) |
| 103TA0700X Psychologist, Adult Development & Aging | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TF0000X Psychologist, Family (Licence: CA 9835) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2024-01-02 |