NPI | 1538449194 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA PSY29794) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071.008597) |
Enumeration Date | 2011-08-26 |
Last Update Date | 2022-01-18 |