NPI | 1235577073 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CA PSY25646) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY25646) |
Enumeration Date | 2013-06-13 |
Last Update Date | 2020-07-10 |