| NPI | 1982814604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 102L00000X Psychoanalyst (Licence: CA PSY#4257) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA PSY#4257) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY#4257) | |
| 103TC1900X Psychologist, Counseling (Licence: CA PSY#4257) | |
| 103TF0000X Psychologist, Family (Licence: CA PSY#4257) | |
| 106H00000X Marriage & Family Therapist (Licence: CA PSY#4257) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-07-08 |