NPI | 1356577415 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI 1352) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY17965) |
Enumeration Date | 2009-06-03 |
Last Update Date | 2015-06-23 |