NPI | 1487918231 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA 24868) |
Additional Taxonomies | 103T00000X Psychologist (Licence: HI 1867) |
Enumeration Date | 2012-06-26 |
Last Update Date | 2023-03-31 |