NPI | 1225117302 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY6300) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301001098) |
Enumeration Date | 2006-11-02 |
Last Update Date | 2007-07-08 |