NPI | 1275615866 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 3352) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY 17570) |
Enumeration Date | 2006-10-20 |
Last Update Date | 2008-01-14 |