NPI | 1629312368 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY6946) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: ID PSY202445) |
Enumeration Date | 2012-11-19 |
Last Update Date | 2015-12-17 |