NPI | 1538710207 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA 33538) |
Additional Taxonomies | 103T00000X Psychologist (Licence: UT 11421644-2504) |
Enumeration Date | 2019-09-24 |
Last Update Date | 2022-08-23 |