NPI | 1700102977 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 26445) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CA PSY 26445) |
Enumeration Date | 2010-04-13 |
Last Update Date | 2014-07-08 |