| NPI | 1407122641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60951973) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: ID PSY 202655) |
| 103TC0700X Psychologist, Clinical (Licence: OR 3094) | |
| Enumeration Date | 2012-03-31 |
| Last Update Date | 2024-09-09 |