| NPI | 1467501734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY0001271) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AK AA02881) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2008-05-10 |