NPI | 1326415472 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60898794) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 37411) |
Enumeration Date | 2015-08-25 |
Last Update Date | 2020-06-13 |