| NPI | 1265684765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY60478357) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY19356) |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2020-04-29 |