NPI | 1891810438 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY-29785) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS 24862) |
Enumeration Date | 2007-03-20 |
Last Update Date | 2018-03-27 |