NPI | 1699738021 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA 9068) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 9068) |
103TF0200X Psychologist, Forensic (Licence: CA 9068) | |
Enumeration Date | 2006-04-07 |
Last Update Date | 2007-07-08 |