NPI | 1912045477 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY15223) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY15223) |
103TF0000X Psychologist, Family (Licence: CA PSY15223) | |
103T00000X Psychologist (Licence: CA PSY15223) | |
Enumeration Date | 2007-02-04 |
Last Update Date | 2014-09-19 |