NPI | 1215051271 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY18219) |
Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA PSY18219) |
103T00000X Psychologist (Licence: CA PSY18219) | |
103TP2701X Psychologist Group Psychotherapy (Licence: CA PSY18219) | |
Enumeration Date | 2007-03-16 |
Last Update Date | 2007-07-08 |