NPI | 1891826558 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60266005) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 22410) |
Enumeration Date | 2007-03-07 |
Last Update Date | 2014-02-03 |