NPI | 1669614723 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA 21573) |
Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA 21573) |
103TC0700X Psychologist, Clinical (Licence: CA 21573) | |
103TC1900X Psychologist, Counseling (Licence: CA 21573) | |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 21573) | |
103TF0000X Psychologist, Family (Licence: CA 21573) | |
Enumeration Date | 2009-04-03 |
Last Update Date | 2009-04-03 |