| NPI | 1316514797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY61024753) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: TX 40082) |
| Enumeration Date | 2021-06-05 |
| Last Update Date | 2024-05-30 |