NPI | 1902114523 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY 23623) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY 23623) |
103TC1900X Psychologist, Counseling (Licence: CA PSY 23623) | |
Enumeration Date | 2010-09-16 |
Last Update Date | 2010-09-16 |