NPI | 1205223849 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY34178) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 9133595-6010) |
103G00000X Clinical Neuropsychologist | |
Enumeration Date | 2015-04-21 |
Last Update Date | 2024-08-23 |