NPI | 1508080284 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA 19520) |
Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: CA 19520) |
103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA 19520) | |
103TC0700X Psychologist, Clinical (Licence: CA 19520) | |
103TF0200X Psychologist, Forensic (Licence: CA 19520) | |
Enumeration Date | 2007-04-12 |
Last Update Date | 2007-07-08 |