| NPI | 1437214111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OR 1439) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: OR 1439) |
| 103TC1900X Psychologist, Counseling (Licence: WA 2078) | |
| 103T00000X Psychologist (Licence: OR 1439) | |
| Enumeration Date | 2006-12-24 |
| Last Update Date | 2008-04-01 |