NPI | 1760629133 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA 3909) |
Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: WA 3909) |
103TB0200X Psychologist, Cognitive & Behavioral (Licence: WA 3909) | |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA 3909) | |
Enumeration Date | 2009-01-07 |
Last Update Date | 2009-01-07 |