NPI | 1508804808 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY20666) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY20666) |
Enumeration Date | 2006-06-02 |
Last Update Date | 2019-09-05 |