| NPI | 1336225184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: ID PSY-203448) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY00001844) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2021-08-17 |