NPI | 1912244401 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY10409) |
Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY10409) |
103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA PSY10409) | |
103TF0000X Psychologist Family (Licence: CA PSY10409) | |
103TF0200X Psychologist Forensic (Licence: CA PSY10409) | |
Enumeration Date | 2013-01-03 |
Last Update Date | 2013-01-03 |