| NPI | 1437542446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 3651) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY60764108) |
| Enumeration Date | 2015-03-15 |
| Last Update Date | 2023-08-08 |