NPI | 1700193547 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY33924) |
Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: CA PSY33924) |
Enumeration Date | 2010-08-31 |
Last Update Date | 2023-11-03 |