| NPI | 1396838983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: GA PSY002508) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA PSY002508) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2011-06-29 |