NPI | 1932369881 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA LEP 1535) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CA LEP 1535) |
Enumeration Date | 2008-06-13 |
Last Update Date | 2008-06-13 |