NPI | 1245240928 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 6032) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY 6032) |
103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA PSY 6032) | |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY 6032) | |
Enumeration Date | 2006-08-08 |
Last Update Date | 2014-07-02 |