NPI | 1750483467 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 16519) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY16519) |
Enumeration Date | 2006-09-02 |
Last Update Date | 2020-05-30 |