NPI | 1609807502 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TA0700X Psychologist, Adult Development & Aging (Licence: CA PSY5027) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY5027) |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY5027) | |
103TE1100X Psychologist, Exercise & Sports (Licence: CA PSY5027) | |
103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: CA PSY5027) | |
305R00000X Preferred Provider Organization (Licence: CA PSY5027) | |
Enumeration Date | 2006-07-06 |
Last Update Date | 2007-07-08 |