NPI | 1154763936 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA 31180) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 31180) |
Enumeration Date | 2013-07-22 |
Last Update Date | 2020-09-24 |