NPI | 1356488217 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NV PY0633) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY17948) |
103TF0200X Psychologist, Forensic (Licence: CA PSY17948) | |
Enumeration Date | 2007-01-31 |
Last Update Date | 2016-03-15 |