NPI | 1083905707 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY.757) |
Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY.757) |
Enumeration Date | 2011-04-28 |
Last Update Date | 2011-05-03 |