| NPI | 1104909894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: OR 1187) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: WA PY-1941) |
| 103TF0200X Psychologist, Forensic (Licence: HI PSY-847) | |
| 103TF0200X Psychologist, Forensic (Licence: CA PSY-11389) | |
| 103TF0200X Psychologist, Forensic (Licence: UT 6271762-2501) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2007-07-08 |