| NPI | 1164701751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 4523) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY60495640) |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2015-09-18 |