NPI | 1134188329 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY00001513) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY00001513) |
Enumeration Date | 2006-03-17 |
Last Update Date | 2019-03-15 |