| NPI | 1144549924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AK PSYP663) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WA PY60255369) |
| Enumeration Date | 2010-05-19 |
| Last Update Date | 2024-04-24 |