| NPI | 1326415472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY60898794) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: TX 37411) |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2020-06-13 |