| NPI | 1194855858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 002244) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist, Clinical (Licence: WA PY61602457) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2025-07-31 |