NPI | 1619180049 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY15781) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY15781) |
103TC1900X Psychologist, Counseling (Licence: CA PSY15781) | |
103TH0004X Psychologist, Health (Licence: CA PSY15781) | |
Enumeration Date | 2007-05-08 |
Last Update Date | 2007-07-08 |