NPI | 1881704864 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY9633) |
103T00000X Psychologist (Licence: CA PSY9633) | |
Enumeration Date | 2006-08-30 |
Last Update Date | 2007-07-08 |