NPI | 1093868010 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY9596) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY9596) |
Enumeration Date | 2007-01-21 |
Last Update Date | 2007-07-14 |