| NPI | 1235640616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: UT 9554281-1205) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WA PY60662054) |
| 103TC0700X Psychologist Clinical (Licence: UT 9554281-2501) | |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2023-06-06 |