NPI | 1568009561 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA 31195) |
Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA 31195) |
Enumeration Date | 2019-12-09 |
Last Update Date | 2024-05-08 |