NPI | 1265410286 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | |
Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY60405036) |
Additional Taxonomies | 103T00000X Psychologist (Licence: NC 2039) |
Enumeration Date | 2006-01-09 |
Last Update Date | 2018-03-12 |