NPI | 1922191527 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2016016621) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY17363) |
Enumeration Date | 2006-10-02 |
Last Update Date | 2016-06-21 |