NPI | 1912329970 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 33813) |
Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA 2893) |
Enumeration Date | 2014-01-10 |
Last Update Date | 2022-11-21 |