| NPI | 1023194297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WI 1230-057) |
| Additional Taxonomies | 103TH0100X Psychologist Health Service (Licence: WI 35007) |
| 103T00000X Psychologist (Licence: WI 1230-057) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: WI 1230-057) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2007-07-09 |