NPI | 1700165602 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY25555) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSB36547) |
Enumeration Date | 2011-08-09 |
Last Update Date | 2018-02-02 |