| NPI | 1437123445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 31017) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY60035461) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2025-01-27 |