NPI | 1710965603 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY20334) |
Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: CA PSY20334) |
Enumeration Date | 2006-01-03 |
Last Update Date | 2007-07-08 |