| NPI | 1124150180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY00003320) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY22824) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2023-11-08 |