NPI | 1700988540 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: MO PYR0533) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY9294) |
Enumeration Date | 2006-09-02 |
Last Update Date | 2018-12-12 |