| NPI | 1184973810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60305193) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810004294) |
| 103TC0700X Psychologist, Clinical (Licence: OR 2320) | |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2025-01-31 |