NPI | 1669500732 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS017345) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY17565) |
Enumeration Date | 2007-03-01 |
Last Update Date | 2013-05-20 |