NPI | 1134353089 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 6707) |
Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging |
Enumeration Date | 2009-05-06 |
Last Update Date | 2009-05-06 |