NPI | 1134262884 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY00001701) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA PY00001701) |
Enumeration Date | 2007-02-14 |
Last Update Date | 2009-01-13 |