NPI | 1275085789 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA 22494) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA 22494) |
103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: CA 22494) | |
103TA0700X Psychologist Adult Development & Aging (Licence: CA 22494) | |
103TB0200X Psychologist Cognitive & Behavioral (Licence: CA 22494) | |
103TC0700X Psychologist Clinical (Licence: CA 22494) | |
103TH0004X Psychologist Health (Licence: CA 22494) | |
103TP2701X Psychologist Group Psychotherapy (Licence: CA 22494) | |
103TR0400X Psychologist Rehabilitation (Licence: CA 22494) | |
Enumeration Date | 2016-11-01 |
Last Update Date | 2016-11-01 |