NPI | 1750670030 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY23882) |
Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: CA PSY23882) |
Enumeration Date | 2011-04-07 |
Last Update Date | 2011-04-07 |