NPI | 1588916738 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY12813) |
Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: CA PSY12813) |
Enumeration Date | 2012-10-12 |
Last Update Date | 2023-10-13 |