NPI | 1255486270 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA PSY 9205) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY 9205) |
103TF0200X Psychologist, Forensic (Licence: CA PSY 9205) | |
Enumeration Date | 2007-01-23 |
Last Update Date | 2007-07-08 |