NPI | 1790980829 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY16566) |
Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA PSY16566) |
103TC1900X Psychologist, Counseling (Licence: CA PSY16566) | |
103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY16566) | |
Enumeration Date | 2007-06-19 |
Last Update Date | 2019-07-09 |