NPI | 1083754089 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI PSY 454) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY28367) |
Enumeration Date | 2007-02-07 |
Last Update Date | 2019-11-18 |