NPI | 1780762658 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY25155) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling |
103TF0000X Psychologist, Family | |
103TP2701X Psychologist, Group Psychotherapy | |
Enumeration Date | 2006-11-01 |
Last Update Date | 2013-01-03 |