NPI | 1750826558 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY60909663) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA 60909663) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-01-03 |
Last Update Date | 2023-08-21 |