| NPI | 1194983015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60156501) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA CA 21900) |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2010-08-10 |