NPI | 1811028111 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA psy7817) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA psy7817) |
103TH0004X Psychologist, Health (Licence: CA PSY-7817) | |
103TH0100X Psychologist, Health Service (Licence: CA PSY-7817) | |
Enumeration Date | 2007-03-08 |
Last Update Date | 2018-07-26 |