| NPI | 1336540392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 3663) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY61286416) |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2024-04-15 |