NPI | 1225280654 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60017842) |
Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: WA PY60017842) |
Enumeration Date | 2008-10-16 |
Last Update Date | 2008-10-16 |