NPI | 1164701751 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 4523) |
Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY60495640) |
Enumeration Date | 2011-08-12 |
Last Update Date | 2015-09-18 |