NPI | 1194531046 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 000) |
Additional Taxonomies | 103T00000X Psychologist |
103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
103TB0200X Psychologist, Cognitive & Behavioral | |
Enumeration Date | 2024-12-05 |
Last Update Date | 2024-12-05 |