NPI | 1568860229 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA 26905) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 531211) |
Enumeration Date | 2014-12-12 |
Last Update Date | 2015-01-15 |