NPI | 1821010273 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA psy8099) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY8099) |
103TH0100X Psychologist, Health Service (Licence: CA PSY8099) | |
103T00000X Psychologist (Licence: CA PSY8099) | |
Enumeration Date | 2006-07-24 |
Last Update Date | 2007-07-08 |