| NPI | 1003115429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60196503) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY12868) |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2013-06-17 |