NPI | 1962608257 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY8543) |
Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: CA PSY8543) |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY8543) | |
103TF0000X Psychologist, Family (Licence: CA PSY8543) | |
103TF0200X Psychologist, Forensic (Licence: CA PSY8543) | |
Enumeration Date | 2007-06-22 |
Last Update Date | 2011-12-14 |