| NPI | 1417342643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: IA 001269) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: IA 000622) |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2015-04-03 |