| NPI | 1164976270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 37807) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY 60593943) |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2025-07-10 |