NPI | 1518275064 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY26562) |
Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
Enumeration Date | 2010-09-17 |
Last Update Date | 2025-05-09 |