| NPI | 1477534360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 1031) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY00001545) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2023-11-02 |