| NPI | 1447442124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY00003409) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 1593) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2015-01-19 |