NPI | 1477534360 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 1031) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY00001545) |
Enumeration Date | 2005-11-08 |
Last Update Date | 2023-11-02 |