| NPI | 1003435694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA 60963309) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 37976) |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2021-05-18 |