NPI | 1902908650 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY15728) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY15728) |
Enumeration Date | 2006-09-02 |
Last Update Date | 2007-07-08 |