NPI | 1124293261 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY 19545) |
Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY 19545) |
Enumeration Date | 2008-04-29 |
Last Update Date | 2008-04-29 |