| NPI | 1275645061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY00003704) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 1830) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2008-08-18 |