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Individual
SAMUEL PARK
Active
Individual
SAMUEL PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY16648
CA
103TC1900X
Counseling Psychologist
PSY16648
CA
Other
Enumeration date
04/29/2008
Last updated
04/29/2008
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