NPI | 1487673596 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: CA 20328) |
Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: CO 1565) |
Enumeration Date | 2006-07-19 |
Last Update Date | 2007-07-08 |