| NPI | 1376862037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP5426) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY60778412) |
| Enumeration Date | 2010-05-20 |
| Last Update Date | 2019-02-21 |