NPI | 1316983562 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY10792) |
Additional Taxonomies | 103TP0814X Psychologist, Psychoanalysis (Licence: CA PSY10792) |
103T00000X Psychologist (Licence: CA PSY10792) | |
Enumeration Date | 2006-06-22 |
Last Update Date | 2007-07-08 |