| NPI | 1376634345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ID PSY-202154) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY00000815) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2013-01-08 |