NPI | 1699384651 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY32257) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 3812-57) |
Enumeration Date | 2020-07-27 |
Last Update Date | 2022-03-21 |