NPI | 1932314937 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY9441) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY9441) |
103TF0200X Psychologist, Forensic (Licence: CA PSY9441) | |
103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: CA PSY9441) | |
Enumeration Date | 2007-05-11 |
Last Update Date | 2007-07-09 |