NPI | 1073695649 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY18263) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CA PSY18263) |
Enumeration Date | 2006-10-20 |
Last Update Date | 2021-03-02 |