NPI | 1346254786 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 20809) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NH 1061) |
Enumeration Date | 2006-07-29 |
Last Update Date | 2010-10-20 |