NPI | 1558670059 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA TE61190395) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY28490) |
Enumeration Date | 2010-09-30 |
Last Update Date | 2021-08-23 |