NPI | 1457412728 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY13433) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY13433) |
103TC1900X Psychologist, Counseling (Licence: CA PSY13433) | |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY13433) | |
Enumeration Date | 2006-12-12 |
Last Update Date | 2007-07-08 |