NPI | 1518138049 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY26041) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 67249902501) |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY26041) | |
Enumeration Date | 2008-03-12 |
Last Update Date | 2014-11-03 |