NPI | 1336307693 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA Psy#9968) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA Psy#9968) |
103TC1900X Psychologist, Counseling (Licence: CA Psy#9968) | |
103TE1100X Psychologist, Exercise & Sports (Licence: CA Psy#9968) | |
Enumeration Date | 2008-05-23 |
Last Update Date | 2008-05-23 |