| NPI | 1003006966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY60351579) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY20354) |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2020-08-06 |