NPI | 1740331610 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 14542) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY 14542) |
103TF0200X Psychologist, Forensic (Licence: CA PSY 14542) | |
Enumeration Date | 2007-01-16 |
Last Update Date | 2013-08-08 |