NPI | 1609955657 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AR 0806P) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY 3413) |
Enumeration Date | 2006-11-02 |
Last Update Date | 2015-12-07 |