NPI | 1093166118 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY61368549) |
Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY61368549) |
Enumeration Date | 2016-06-29 |
Last Update Date | 2024-07-29 |