| NPI | 1437381720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AK 144849) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY60340131) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY26922) | |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810004895) | |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2021-10-11 |