NPI | 1558473876 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TA0700X Psychologist, Adult Development & Aging (Licence: CA PSY7206) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY7206) |
103TC1900X Psychologist, Counseling (Licence: CA PSY7206) | |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY7206) | |
103TF0200X Psychologist, Forensic (Licence: CA PSY7206) | |
103T00000X Psychologist (Licence: CA PSY7206) | |
Enumeration Date | 2006-08-31 |
Last Update Date | 2007-07-08 |