| NPI | 1013281781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810004610) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WA 60491890) |
| Enumeration Date | 2012-02-28 |
| Last Update Date | 2017-03-09 |