| NPI | 1477690576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ID PSY-202347) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY3410) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2024-06-11 |