NPI | 1902116676 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY 11789) |
Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CA OT 5173) |
Enumeration Date | 2010-10-15 |
Last Update Date | 2010-10-15 |