NPI | 1467803817 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY35018) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CO PSY0005845) |
Enumeration Date | 2016-06-28 |
Last Update Date | 2024-08-06 |