NPI | 1902421415 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY33397) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CO PSY.0005139) |
103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY33397) | |
103TS0200X Psychologist, School (Licence: CA CTC-200059350) | |
Enumeration Date | 2020-06-10 |
Last Update Date | 2023-02-02 |