| NPI | 1164930657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 5944) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PR 5944) | |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2018-01-18 |