NPI | 1033430830 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60123123) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 2666) |
Enumeration Date | 2010-06-15 |
Last Update Date | 2024-07-31 |