NPI | 1710206420 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY12365) |
Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: CA PSY12365) |
Enumeration Date | 2010-05-19 |
Last Update Date | 2014-03-11 |