NPI | 1316474026 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: CA 28887) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY 28887) |
Enumeration Date | 2017-05-12 |
Last Update Date | 2024-07-18 |