| NPI | 1366620239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA 1861) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 1137) |
| Enumeration Date | 2008-02-04 |
| Last Update Date | 2008-02-04 |