| NPI | 1386146439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA 61502334) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 32794) |
| 103TC0700X Psychologist, Clinical (Licence: AK 153650) | |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2026-01-07 |