NPI | 1588715155 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY24580) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
103TC2200X Psychologist, Clinical Child & Adolescent | |
Enumeration Date | 2007-01-12 |
Last Update Date | 2020-08-04 |