NPI | 1073712584 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY19185) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY19185) |
103TF0200X Psychologist, Forensic (Licence: CA PSY19185) | |
Enumeration Date | 2007-07-13 |
Last Update Date | 2007-07-13 |