NPI | 1083111934 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY32414) |
Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: CA PSY32414) |
Enumeration Date | 2018-04-08 |
Last Update Date | 2024-03-21 |