NPI | 1164930657 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 5944) |
Additional Taxonomies | 103TH0100X Psychologist, Health Service |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PR 5944) | |
Enumeration Date | 2018-01-18 |
Last Update Date | 2018-01-18 |