| NPI | 1033430830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60123123) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 2666) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2016-06-02 |