NPI | 1689978439 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 27984) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: HI 2013) |
Enumeration Date | 2011-01-07 |
Last Update Date | 2024-08-15 |