NPI | 1255669453 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PSY60059955) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA 60059955) |
103TC0700X Psychologist, Clinical (Licence: VT 048.0134250) | |
Enumeration Date | 2009-11-27 |
Last Update Date | 2022-11-09 |