| NPI | 1225245491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 862) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA 1870) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2007-07-08 |