NPI | 1962699413 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY21496) |
Additional Taxonomies | 103T00000X Psychologist |
103TC0700X Psychologist, Clinical (Licence: CA PSY 21496) | |
Enumeration Date | 2007-09-28 |
Last Update Date | 2025-03-12 |