NPI | 1598804783 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 16826) |
Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
103TB0200X Psychologist, Cognitive & Behavioral | |
103T00000X Psychologist (Licence: CA PSY 16826) | |
Enumeration Date | 2007-02-05 |
Last Update Date | 2010-11-02 |