NPI | 1336429000 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 23917) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY 23917) |
103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY 23917) | |
103TB0200X Psychologist, Cognitive & Behavioral (Licence: VA 0810004408) | |
103TC0700X Psychologist, Clinical (Licence: VA 0810004408) | |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY 23917) | |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VA 0810004408) | |
103TF0200X Psychologist, Forensic | |
103TF0200X Psychologist, Forensic (Licence: CA PSY23917) | |
103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: VA 0810004408) | |
Enumeration Date | 2011-08-25 |
Last Update Date | 2022-01-11 |