NPI | 1487427779 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA psy34787) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 026088) |
Enumeration Date | 2023-10-30 |
Last Update Date | 2024-02-02 |