| NPI | 1972627800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA psy6517) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA psy6517) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA psy6517) | |
| 103TC0700X Psychologist, Clinical (Licence: CA psy6517) | |
| 103TP0814X Psychologist, Psychoanalysis (Licence: CA psy6517) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CA psy6517) | |
| Enumeration Date | 2007-03-17 |
| Last Update Date | 2007-07-08 |