| NPI | 1265410286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY60405036) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 2039) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2018-03-12 |