NPI | 1194986570 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA psy24131) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA psy24131) |
Enumeration Date | 2008-06-19 |
Last Update Date | 2011-07-15 |