| NPI | 1982692497 |
|---|---|
| Former Name | DAVID GLENN DAVIDSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 3732) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 18748) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2010-01-20 |