NPI | 1992783112 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 21811) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 3245) |
Enumeration Date | 2006-01-06 |
Last Update Date | 2010-05-28 |