NPI | 1609825322 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60279451) |
Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS015188L) |
Enumeration Date | 2006-05-09 |
Last Update Date | 2020-05-22 |