NPI | 1518200039 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 2603) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 25546) |
Enumeration Date | 2013-04-03 |
Last Update Date | 2016-07-22 |