NPI | 1891806675 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY16221) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY61229677) |
Enumeration Date | 2006-08-31 |
Last Update Date | 2022-09-09 |