NPI | 1154545275 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY7489) |
Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: CA PSY7489) |
Enumeration Date | 2007-04-12 |
Last Update Date | 2007-07-09 |