NPI | 1821011891 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY60462687) |
Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CO 1771) |
Enumeration Date | 2006-07-25 |
Last Update Date | 2021-05-28 |