NPI | 1528609583 |
---|---|
Former Name | KATHRYN WILLIAMS |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810006213) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 8010006213) |
Enumeration Date | 2019-10-01 |
Last Update Date | 2025-01-09 |