| NPI | 1285716951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 1752) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA 1120) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2009-12-14 |