NPI | 1326448788 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY31720) |
Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: CA PSY31720) |
103TC0700X Psychologist, Clinical (Licence: CA PSY31720) | |
Enumeration Date | 2014-09-03 |
Last Update Date | 2024-08-21 |