| NPI | 1366881500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY60425207) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WY 532) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2015-03-04 |