NPI | 1477573608 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: CA PSY 16193) |
Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation (Licence: CA PSY 16193) |
103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA PSY 16193) | |
103TC0700X Psychologist, Clinical (Licence: CA PSY 16193) | |
Enumeration Date | 2006-07-20 |
Last Update Date | 2007-07-08 |