NPI | 1841206109 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY12890) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 1436) |
Enumeration Date | 2006-07-31 |
Last Update Date | 2007-07-08 |