NPI | 1649318015 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY22993) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY22993) |
103TC0700X Psychologist, Clinical (Licence: CA PSY22993) | |
103TC1900X Psychologist, Counseling (Licence: CA PSY22993) | |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY22993) | |
Enumeration Date | 2007-02-01 |
Last Update Date | 2023-12-06 |