NPI | 1417008673 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 23144) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY 23144) |
103TF0000X Psychologist, Family (Licence: CA PSY 23144) | |
103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: CA PSY 23144) | |
103TP2701X Psychologist, Group Psychotherapy (Licence: CA PSY23144) | |
Enumeration Date | 2007-01-15 |
Last Update Date | 2018-12-14 |