NPI | 1740443860 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY 00003860) |
Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: WA PY00003860) |
1041C0700X Social Worker Clinical (Licence: OR L6002) | |
Enumeration Date | 2008-07-09 |
Last Update Date | 2023-11-28 |