NPI | 1730310780 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA psy25197) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA psy25197) |
Enumeration Date | 2009-08-06 |
Last Update Date | 2012-10-22 |