| NPI | 1427388859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS016690) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY61150763) |
| Enumeration Date | 2010-01-07 |
| Last Update Date | 2021-08-31 |