NPI | 1275598401 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 19891) |
Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
103TB0200X Psychologist, Cognitive & Behavioral | |
Enumeration Date | 2006-04-19 |
Last Update Date | 2021-08-31 |