NPI | 1265839138 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY27569) |
Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: CA PSY27569) |
103TE1100X Psychologist, Exercise & Sports (Licence: CA PSY27569) | |
103T00000X Psychologist (Licence: CA PSB 94020704) | |
103TP2701X Psychologist, Group Psychotherapy (Licence: CA PSB 94020704) | |
Enumeration Date | 2014-11-20 |
Last Update Date | 2020-09-10 |