| NPI | 1225280654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY60017842) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: WA PY60017842) |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2008-10-16 |