NPI | 1720097009 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY11455) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY11455) |
Enumeration Date | 2006-08-05 |
Last Update Date | 2007-07-08 |