NPI | 1356875116 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY34021) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY34021) |
Enumeration Date | 2017-04-18 |
Last Update Date | 2024-04-29 |