NPI | 1073950267 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY13656) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling |
103TE1100X Psychologist, Exercise & Sports | |
103TP0814X Psychologist, Psychoanalysis | |
Enumeration Date | 2013-05-28 |
Last Update Date | 2016-03-17 |