NPI | 1093711749 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY11922) |
Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: CA PSY11922) |
103TR0400X Psychologist, Rehabilitation (Licence: CA PSY11922) | |
Enumeration Date | 2005-06-27 |
Last Update Date | 2020-02-10 |