NPI | 1760637607 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 14289) |
Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: CA PSY 14289) |
103TP2701X Psychologist, Group Psychotherapy (Licence: CA PSY 14289) | |
Enumeration Date | 2008-11-19 |
Last Update Date | 2008-11-19 |