| NPI | 1083184550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY60888285) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AZ PSY-004928) |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2021-10-24 |